A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample.
OBJECTIVE
The author assesses performance characteristics of the 5-item mental health scale (MHI-5) of the Medical Outcomes Study Short Form Health Survey when used as a psychiatric case-finding measure for human immunodeficiency virus (HIV) seropositive outpatients.


METHODS
Ninety-five HIV seropositive outpatients from two primary care practices were recruited and cross-sectionally studied. All subjects completed the MHI-5. Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used as the gold standard in assessing Axis I psychiatric disorders in the previous 6 months.


RESULTS
Thirty-three of 95 (35%) subjects had Axis I disorders (Axis I): 18 of 33 (55%) had a diagnosis of major depression (MD); 15 of 33 (45%) had another diagnosis (AD). Areas under receiver operator characteristic (ROC) curves were 0.76 (95% confidence interval [CI], 0.65, 0.87; Axis I), 0.84 (95% CI, 0.74, 0.94; MD), and 0.55 (95% CI, 0.38, 0.72; AD). The area under the MD curve was significantly greater than that for the AD curve (P = 0.0017). The optimal subscale score cut-off point on the MD curve was 52. Test characteristics for this cut-off point were: sensitivity, 83%; specificity, 65%; positive predictive value, 36%; negative predictive value, 94%; likelihood ratio for a positive test, 2.37; and likelihood ratio for a negative test, 0.26.


CONCLUSIONS
The MHI-5 is the first short psychiatric case-finding measure for which performance characteristics have been reported for HIV seropositive outpatients. Test characteristics suggest that it may be a useful case-finding measure for these patients. A positive finding may indicate a diagnosis of recent major depression.
Holmes
W C
WC
Division of General Internal Medicine and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA. holmeswc@mail.med.upenn.edu
D000328:Adult; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis*; D006679:HIV Seropositivity / Q000150:complications / Q000523:psychology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008609:Mental Status Schedule; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012307:Risk Factors; D012680:Sensitivity and Specificity